Device and procedure for implanting a dental implant

ABSTRACT

Various tools and procedures are provided for implantation of an implant at a target site. The procedure can comprise performing an osteotomy at the target site; placing a guide sleeve into the osteotomy; inserting a coring tool into the guide sleeve; coring the target site up to a depth less than the depth of the osteotomy, the coring tool being configured to collect autogenous bone material from the target site during the coring of the target site; placing the implant at the implant site; and grafting the autogenous bone material into selected portions of the target site.

FIELD OF THE INVENTIONS

The present inventions relate generally to dental implant systems andmethods of using the same. More specifically, the present inventionsrelate to methods and apparatuses for implant placement procedures andsystems.

DESCRIPTION OF THE RELATED ART

Implant dentistry involves the restoration of one or more teeth in apatient's mouth using artificial components. Such artificial componentstypically include a dental implant and a prosthetic tooth and/or a finalabutment that is secured to the dental implant.

The dental implant is implanted into the alveolar bone (i.e., jawbone)of a patient. Typically, the surgeon first accesses the alveolar bonethrough the patient's gum tissue and removes any remains of the tooth tobe replaced. Next, the specific site in the alveolar bone where theimplant will be anchored is prepared by drilling and/or reaming toaccommodate the width of the dental implant to be inserted. Then, thedental implant is inserted into the hole, typically by screwing,although other techniques are known for introducing the implant in thejawbone.

As illustrated in FIGS. 1-3, a target site 10 for placement of animplant, such as an extraction site, can include several dental alveolior tooth sockets 12. FIGS. 2-3 illustrate the placement in one of thesockets 12 of a prior art dental implant 14 having an angled abutment.This procedure is generally advantageous because it allows a surgeon touse the existing sockets 12 in order to place the implant 14, thusallowing the implant 14 to be placed relatively quickly.

FIG. 3 also illustrates that although the implant 14 can be placed intoone of the sockets 12, a final restoration 16 installed onto the implant14 will not be centered with respect to a centerline 18 of the targetsite 10. In other words, because the sockets 12 of such a site 10 aregenerally not centered relative to the centerline 18 of the site 10, theimplant 14 will similarly be off-center. As a result, the finalrestoration 16 may be misaligned with respect to adjacent teeth and iscantilevered on the implant potentially adding additional stresses tothe implant.

In contrast, an alternative procedure is to allow the extraction sitewhere the tooth has been removed to heal prior to the implantation of adental implant. For example, after removing the tooth, the sockets ofthe extraction site are sutured and further surgery is delayed until thebone heals to provide a “healed ridge.” Depending on the tooth beingreplaced, such a procedure may be preferable. In fact, because the siteis now healed, the surgeon can place the implant in any desirableorientation relative to the bone. However, allowing the site to heal cantake up to several months which can be a burden on the patient.

Recently, threaded basket-type implants have been developed, which areparticularly suited for implantation in the molar socket of theextraction site. For example, as described in U.S. Patent Publication2005/0164146, to Cantor, a tubular anchoring element that can beinserted into a molar socket of the extraction site immediately afterthe tooth is removed. The molar socket is prepared by creating a holethat generally corresponds to the cervical collar of the socket. Thehole is preferably configured such that it provides a large periphery ofcontact between the anchoring element and the cervical collar. Further,a flat surface can be prepared on the residual interradicular bone tosupport a portion of the anchoring element. Thus, the anchoring elementcan be implanted into the prepared molar socket. The prepared molarsocket can provide good initial stability to the anchoring element andsubsequent osseointegration allows the anchoring element to be furtherstabilized. I

In a similar, as described in U.S. Patent Publication 2008/0003539, toLundgren, a trephine drill can be used to prepare an implant site forreceiving an anchoring element. The bone anchoring element comprises athreaded tubular implant that is coupled to a prosthetic component. Thetrephine drill is used to cut through connecting tissue, and anunderlying thin bone layer is hacked or pressed to the bottom of thegroove by means of a lifter. The tubular implant can then be insertedinto the resulting hole.

SUMMARY

Despite the improvements made in the prior dental implants and dentalimplant procedures, there is still a need for improved procedures anddevices for to ensure that dental implants are quickly reliably placedin the patient in a manner that consistently results in quick and properosseointegration.

Accordingly, an aspect of at least one embodiment of the presentinventions includes the realization that a dental implant procedure canbe expedited if alternative tooling and procedures were utilized. Anaspect of at least one of the embodiments disclosed herein is therealization that the use of an angled abutment causes a finalrestoration to be installed in an off-center orientation that misalignsthe final restoration relative to the position of the original tooth andadjacent teeth.

Further, according to at least one of the embodiments disclosed hereinis the realization that in preparing a target site to receive a dentalimplant, a central area or core of the target site may be used not onlyto anchor a straight implant, thereby eliminating the need to use anangled abutment and implant in order to correct the angle of an implantplaced in a tooth socket, but can also provide valuable autogenous bonematerial that can be grafted into selected portions or cavities of thetarget site. In addition, the implant can be used at target sites suchas, for example, where the bone height is lower. Bone height can belower, for example, as a result of regression of the bone, or along themandible or elsewhere where there is a low bridge ridge.

Another aspect of at least one embodiment of the present inventionsincludes the realization that a drill, such as a trephine drill, can beused to create a cylindrical osteotomy at the target site. The osteotomycan traverse one or more tooth sockets and extend into the bone toward acentral area or core of the target site. As such, the resultingcylindrical osteotomy can create an interior bone cylinder or post thatextends upwardly from a base of the target site.

One of the advantage of some of the embodiments disclosed herein is thata guide tool can be provided for assisting in the use of other tools,such as the trephine drill mentioned above and others such as a facingburr. The guide tool can be particularly advantageous because it can aida surgeon in supporting a tool in a given orientation during use of thetool. As a result, the surgeon will tend to have greater control overthe tool. Thus, the surgeon can be enabled to precisely place toolsduring procedures and improve cutting accuracy. Additionally, theimproved control over the tools can facilitate safe handling of thetools.

For example, in some embodiments, it is particularly advantageous to usethe guide tool with the trephine drill. The target site, as mentionedabove, can often include several tooth sockets. Therefore, the portionof the target site that lies at the surface of the jawbone where thetooth sockets converge can often be defined by several sharp edges.Without the use of the guide tool, it can be particularly difficult toplace the trephine drill in such a manner as to maintain a desiredposition and trajectory of the drill. During use, the trephine drill cansometimes be very unstable and wobble when it contacts the gum tissueand/or the bone. However, by using the guide tool, the surgeon canmaintain a desired position even against sharp edges of varying heights.Further, the trajectory of the drill can also be precisely controlled,thus optimizing the osteotomy. Accordingly, the bone post created by theosteotomy can be formed precisely to a desired geometry.

In some embodiments, the bone post created by the osteotomy can besurrounded by a generally cylindrical cavity or wall of bone that isspaced from the bone post at a width defined by the width of thecylindrical drill. The bone post can be formed using a coring tool, suchas an interradicular burr, which can be configured to collect bonematerial while preparing the bone post. The bone post and thecylindrical cavity can traverse portions of existing tooth sockets.However, the surfaces of the bone post and the cylindrical cavity canextend generally concentrically and provide sufficient support forengaging threads of a hollow lower portion of an implant. Wheninstalled, the implant can engage at least one of the bone post and thecylindrical cavity of the prepared site in order to anchor the implantat the target site and autogenous bone material can be grafted into thetarget site.

Accordingly, various embodiments disclosed herein also include therealization that a placement procedure can be developed in which afterthe target site is prepared and the implant is placed, bone tissueremoved from the target site can be selectively grafted into the targetsite in order to fill cavities of the target site, such as empty toothsockets and enhance the stability of the implant. For example, bonetissue collected during a reaming or coring process can be grafted intothe target site and provide additional stability for the implant.

Furthermore, embodiments of the procedure and tools disclosed herein canprovide a cutting tool that is configured to create a measured cut intothe target site. For example, the tool, such as the interradicular burrmentioned above, can comprise a limit flange at a proximal end thereofthat can be used to allow the surgeon to limit the longitudinal travelof the tool. In some embodiments, the flange can provide a visualindication to the surgeon. Further, in other embodiments, the flange canextend radially outwardly from the tool such that the flange limits thetravel of the tool via interference. In other words, the shape of theflange can prevent or limit movement of the tool.

In accordance with an embodiment, a procedure is provided forimplantation of an implant at a target site. The procedure can comprisethe steps of: performing an osteotomy at the target site, the osteotomydefining a central bone post, a cavity wall, and an annular spaceintermediate the bone post and the cavity wall; collecting autogenousbone material from the target site; placing the implant at the targetsite; and grafting the autogenous bone material into selected portionsof the target site.

The step of performing the osteotomy can comprise using a trephinedrill. The step of performing the osteotomy can also comprise using aguide tool with the trephine drill for placing the trephine drill at thetarget site. The step of performing the osteotomy can further compriseusing an angled guide tool.

The procedure can further comprise inserting a coring tool into theosteotomy to core the osteotomy. In this regard, the procedure can alsofurther comprise coring the target site up to a depth less than thedepth of the osteotomy. Further, the procedure can also comprisecollecting autogenous bone material from the target site during coringof the osteotomy.

Additionally, the procedure can comprise placing a guide sleeve into theosteotomy. The step of inserting the coring tool can comprise insertingthe coring tool into the guide sleeve. In some embodiments, the coringof the target site can comprise inserting the coring tool into thesleeve until a limit flange of the coring tool contacts a limit flangeof the guide sleeve. The coring of the target site can also comprisecoring the target site up to a depth being approximately 2 mm less thana depth of the osteotomy. The step of placing the guide sleeve cancomprise inserting the guide sleeve through an aperture of a guide toolfor placing the cylindrical sleeve into the osteotomy. The step ofplacing the guide sleeve can comprise using an angled guide tool.

The procedure can also comprise facing the target site with a facingburr after performing the osteotomy. “Facing” of the target site cancomprise removing at least a portion of an upper surface of the targetsite in order to smooth out the target site. The facing operation canprovide a smooth upper surface that facilitates proper seating of theimplant. Further, the facing operation can also allow a surgeon tocollect autogenous bone material. As described further herein, thefacing operation can provide a generally flat upper surface that extendsbeyond a perimeter of an osteotomy at the target site. The step offacing the target site can comprise using a guide tool with the facingburr for placing the facing burr at the target site.

The step of grafting the autogenous bone material into the selectedportions of the target site can comprise grafting the autogenous bonematerial into tooth sockets remaining after extraction of a tooth.

The procedure can further comprise inserting one of a plurality oftry-in components into the osteotomy at the target site. The procedurecan further comprise transferring a threaded pattern to the target siteusing a tapping tool.

In accordance with another embodiment, a procedure is provided forimplantation of an implant at a target site. The procedure can comprisethe steps of: making an osteotomy at the target site, the osteotomyextending from an upper surface of the target site into the bone towarda lower portion thereof, the osteotomy being made generally transverselyrelative to tooth sockets to define a bone post extending upwardly fromthe lower portion of the target site and a cavity wall adjacent to thebone post, the bone post being generally cylindrical, the cavity wallgenerally encircling the bone post and defining an annular spacetherebetween, the annular space being configured to receive a lowerportion of the implant; placing a guide sleeve into the osteotomy;removing bone material from the bone post up to a depth less than thedepth of the osteotomy; and placing the implant at the target site inthe osteotomy with the lower portion thereof being received into theannular space of the osteotomy and an inner cavity of the implantreceiving the bone post therein.

The procedure can further comprise grafting the bone material intoselected portions of the target site. The procedure can also compriseinserting an interradicular bone coring tool into the guide sleeve forremoving the bone material from the bone post.

The step of placing the guide sleeve can comprise inserting the guidesleeve through an aperture of a guide tool for placing the guide sleeveinto the osteotomy. The step of placing the guide sleeve can compriseusing an angled guide tool. The procedure can also comprise facing thetarget site with a facing burr after performing the osteotomy.

In accordance with another embodiment, a combination is provided forcreating a prepared site for a dental implant. The prepared site cancomprise an annular space and a bone posed defining a shelf. Thecombination can comprise a trephine drill and an interradicular burr.The trephine drill can define inner and outer diameters. The outerdiameter of the trephine drill can be approximately equal to a minordiameter of external threads on the implant, and the inner diameter canbe approximately equal to a major diameter of internal threads on theimplant. The interradicular burr can define an outer diameter being lessthan the inner diameter of the trephine drill.

In some embodiments, the combination can further comprise a guidesleeve. The guide sleeve can define inner and outer diameters. The guidesleeve can be generally cylindrical. The outer diameter can beapproximately equal to the outer diameter of the trephine drill, and theinner diameter can be approximately equal to the inner diameter of thetrephine drill. The guide sleeve can be configured to removably receivethe interradicular burr therein. The guide sleeve can comprise a limitflange at a proximal end thereof. The burr can comprise a limit flangeat a proximal end thereof. Further, the burr can define an operationallongitudinal length that is less than an effective longitudinal lengthof the guide sleeve.

The combination can further comprise an implant. The implant can definean outer diameter. In this regard, the outer diameter of the trephinedrill can be approximately equal to the outer diameter of the implant.

Additionally, the interradicular burr can be configured to collect bonematerial. In this regard, the interradicular burr can have a pluralityof flutes. The flutes can be configured to collect bone material duringoperation of the interradicular burr against the bone at the targetsite.

In accordance with some embodiments, the combination further comprises aguide tool defining at least one support structure formed at a distalend thereof. The support structure can define a receiving aperturehaving an inner geometry corresponding to the outer diameter of one ofthe trephine drill and the interradicular burr for supporting therespective one of the trephine drill and the interradicular burr. Insome embodiments, the guide tool can comprise two support structuresformed at opposing ends thereof. In this regard, the inner geometry of afirst support structure can correspond to the outer diameter of thetrephine drill and the inner geometry of a second support structure cancorrespond to the outer diameter of the interradicular burr.

Further, some embodiments of the combination can also comprise a tappingtool. The tapping tool can comprise a threaded surface for transferringa threaded pattern to the prepared site. In yet other embodiments, thecombination can comprise at least one try-in component. The try-incomponent can define inner and outer diameters being approximately equalto the inner and outer diameters of the trephine drill.

In another embodiment, a combination is provided for performing animplantation of an implant at a target site. The combination cancomprise a guide sleeve and an interradicular burr. The guide sleeve candefine inner and outer diameters. The guide sleeve can also comprise alimit flange at a proximal end thereof. Further, the guide sleeve candefine an effective longitudinal length. The interradicular burr candefine an outer diameter that is less than the inner diameter of theguide sleeve such that the burr can be removably received within theguide sleeve. Additionally, the burr can define an operationallongitudinal length that is less than the effective longitudinal lengthof the guide sleeve. The burr can comprise a corresponding limit flangeconfigured to contact the limit flange of the guide sleeve when the burris inserted into the guide sleeve. The corresponding limit flange of theburr can be configured to limit the longitudinal movement of the burrwithin the guide sleeve.

Additionally, the limit flange of the guide sleeve can be a generallycircular planar flange. The limit flange of the burr can be a generallycircular planar flange. Further, the interradicular burr can beconfigured to include a plurality of flutes for collecting bonematerial.

Some embodiments of the combination can be configured such that alongitudinal length of the interradicular burr is less than alongitudinal length of the guide sleeve. In other embodiments,longitudinal lengths of the burr and the guide sleeve can be configuredsuch that a distal end of the burr is spaced approximately 2 mm from adistal end of the guide sleeve when the interradicular burr is insertedto within the guide sleeve. The combination can further comprise animplant having an outer diameter. The outer diameter of the implant canbe approximately equal to the outer diameter of the guide sleeve.

The combination can also further comprise a trephine drill defininginner and outer diameters. The outer diameter of the trephine drill canbe approximately equal to the outer diameter of the guide sleeve. Theinner diameter of the trephine drill can be approximately equal to theouter diameter of the burr. In accordance with such embodiments, thecombination further comprises a guide tool defining at least one supportstructure formed at a distal end thereof. The support structure candefine a receiving aperture having an inner geometry corresponding tothe outer diameter of one of the trephine drill and the interradicularburr for supporting the respective one of the trephine drill and theinterradicular burr. In some embodiments, the guide tool can comprisetwo support structures formed at opposing ends thereof. In this regard,the inner geometry of a first support structure can correspond to theouter diameter of the trephine drill and the inner geometry of a secondsupport structure can correspond to the outer diameter of theinterradicular burr. In other embodiments, it is contemplated that theouter diameter of the trephine drill can be approximately equal to theouter diameter of the facing burr.

In yet another embodiment, the combination can comprise a guide tooldefining at least one support structure formed at a distal end thereof.The support structure can define a receiving aperture having an innergeometry corresponding to the outer diameter of the interradicular burrfor supporting the interradicular burr.

Further, some embodiments of the combination can also comprise a tappingtool. The tapping tool can comprise a threaded surface for transferringa threaded pattern to the prepared site. In yet other embodiments, thecombination can comprise at least one try-in component. The try-incomponent can define inner and outer diameters being approximately equalto the inner and outer diameters of the trephine drill.

BRIEF DESCRIPTION OF THE DRAWINGS

The abovementioned and other features of the inventions disclosed hereinare described below with reference to the drawings of the preferredembodiments. The illustrated embodiments are intended to illustrate, butnot to limit the inventions. The drawings contain the following figures:

FIG. 1 is a perspective view of a target site of a jawbone from which atooth, such as a molar, has been extracted.

FIG. 2 is a perspective view of the target site shown in FIG. 1 in whicha dental implant has been installed in a socket of the target site.

FIG. 3 is a cross-sectional side view of the target site and implantshown in FIG. 2, wherein the implant includes an angled abutment.

FIG. 4 is a cross-sectional perspective view of a prepared target site,in accordance with an embodiment of the present inventions.

FIG. 5A is a cross-sectional perspective view of the prepared targetsite shown in FIG. 4 wherein a dental implant has been placed, accordingto an embodiment.

FIG. 5B is a cross-sectional side view of the prepared target site shownin FIG. 4 wherein the dental implant and a final restoration have beenplaced, according to an embodiment.

FIG. 6A is a perspective view of a trephine drill having a hollow bore,in accordance with an embodiment.

FIG. 6B is a cross-sectional side view of the trephine drill of FIG. 6A.

FIG. 6C is a perspective view of a target site after the application ofthe trephine drill, according to an embodiment.

FIG. 7A is a perspective view of a trephine drill comprising a burrcomponent, in accordance with an embodiment.

FIG. 7B is a cross-sectional side view of the trephine drill of FIG. 7A.

FIG. 8A is a perspective view and an enlarged view of a guide tool inaccordance with an embodiment.

FIG. 8B is a perspective view of the guide tool of FIG. 8A supportingthe trephine drill, according to an embodiment.

FIG. 9A is a perspective view of a facing burr in accordance with anembodiment.

FIG. 9B is a perspective view of a target site after the application ofthe facing burr, according to an embodiment.

FIG. 9C is a perspective view of a facing burr in accordance withanother embodiment.

FIG. 10A is a perspective view of a guide sleeve in accordance with anembodiment.

FIG. 10B is a cross-sectional perspective view of the sleeve of FIG. 10Abeing placed into a target site, according to an embodiment.

FIG. 10C is a perspective view of a sleeve of FIG. 10A being placed at atarget site using a guide tool, according to an embodiment.

FIG. 11A is a perspective view of an interradicular burr in accordancewith body an embodiment.

FIG. 11B is a cross-sectional perspective view of a target site duringthe application of the interradicular burr, according to an embodiment.

FIG. 11C is a cross-sectional side view of a target site illustratingthe application of an interradicular burr and a guide sleeve, accordingto an embodiment.

FIG. 11D is a perspective view of an interradicular burr subsequent touse and illustrating collection of bone material in flutes of the burr,according to an embodiment.

FIG. 12A is a perspective view of a tap tool in accordance with anembodiment.

FIG. 12B is a perspective view of a target site at which the tap tool isused, according to an embodiment.

FIG. 13 is a perspective view of a try-in component in accordance withan embodiment.

FIG. 14A is a perspective view of an implant in accordance with anembodiment.

FIG. 14B is a cross-sectional side view of the implant of FIG. 14A.

FIG. 14C as a cross-sectional perspective view of the implant of FIG.14A being placed at a prepared extraction site, according to anembodiment.

FIG. 15 is a perspective view of an implant driver in accordance with anembodiment.

FIG. 16 is a perspective view of another implant driver in accordancewith an embodiment.

FIG. 17 is another perspective view of the implant driver of FIG. 16.

FIG. 18 is a side view of the implant driver of FIG. 16.

FIG. 19 is an end view of a proximal end of the implant driver of FIG.16.

FIG. 20 is an end view of a distal end of the implant driver of FIG. 16.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

While the present description sets forth specific details of variousembodiments, it will be appreciated that the description is illustrativeonly and should not be construed in any way as limiting. Furthermore,various applications of such embodiments and modifications thereto,which may occur to those who are skilled in the art, are alsoencompassed by the general concepts described herein.

As discussed above, previous implantation procedures have variousdisadvantages. For example, when a tooth is extracted and replaced withan implant, a surgeon would have to utilize existing tooth sockets inorder to perform such a procedure within a short time frame.Unfortunately, in order to perform such a procedure, an implant wouldrequire that an angled abutment be used in addition to the implant inorder to compensate for the off-axis geometries of the tooth sockets. Asnoted above, the use of an angled abutment results in an off-centerfinal restoration. In another example, a surgeon may be entirely unableto use existing tooth sockets of an extraction site. Therefore, thesurgeon would have to allow the extraction site to heal completely, thusproducing a healed ridge. Such a procedure could require severaladditional months before an implant could be placed.

In accordance with at least one of the embodiments disclosed herein, animplant placement procedure is provided that enables a surgeon to placean implant directly into a target site in a generally verticalorientation, thereby eliminating the need for angled abutments andimplants as well as the need for significant periods of time betweensteps in the procedure. In particular, some embodiments provide for animplant placement procedure in which a target site is prepared bycreating a hollow and generally cylindrical osteotomy at the targetsite. The osteotomy can be formed to provide several surfaces that canbe engaged by a dental implant in order to securely install the implantat the target site.

FIG. 4 is a cross-sectional perspective view taken along a mandible orjawbone 100 of a patient. The jawbone 100 comprises a layer of gumtissue 102 and bone tissue 104. The view shown in FIG. 4 illustrates theconfiguration of a finished or prepared site 110 according to oneembodiment. As described herein, the prepared site 110 is formed at atarget or implant site 112. The target site 112 can be used forimplanting a dental implant or tooth replacement for any tooth, such asan incisor, a canine, a bicuspid, or a molar. In some embodiments, thetarget site 112 can be a fresh extraction site from which a tooth hasbeen removed, a molar extraction site, a healed ridge or healedextraction site, or other site along the dental cavity (e.g., a sitethat a result of regression of the bone, or along the mandible orelsewhere where there is a low bridge ridge). As such, the target sitecan comprise one or more dental alveoli or tooth sockets 114. Forexample, after a tooth has been removed, the tooth sockets 114 generallyremain exposed. In the figures used to illustrate certain embodiments,the tooth is shown as being a molar, and the target site is anextraction site.

As noted above, some implantation procedures may utilize existing toothsockets in order to place the implant. However, as discussed herein,embodiments of the present inventions enable a surgeon to prepare atarget site and install an implant regardless of the configuration ofthe target site, whether the target site includes existing toothsockets, a healed ridge or otherwise configured dental geometry.Further, embodiments also enable a surgeon to perform in implantprocedure in a single day. Finally, embodiments disclosed herein alsoprovide for an implant that is more securely retained in the jawbone dueto the unique structure of the implant. Therefore, it should beappreciate that embodiments of the procedures and instruments describedherein can be used in an extraction site, a molar extraction site, ahealed ridge, or a site without tooth sockets.

The prepared site 110 shown in FIG. 4 includes a central bone post 120,a cylinder cavity or wall 122, and an annular space 124 formed betweenthe bone post 120 and the cavity 122. The annular space 124 can extendto a desirable depth into the bone 104 of the jawbone 100. As will beappreciated by one of skill in the art, the configuration of any toothsockets 114 and the size of the target site 112 provide importantfactors for determining not only the depth of the annular space 124, butalso the diameter of the space 124.

For example, it is contemplated that when replacing a molar, a targetsite or an extraction site might be between 10-12 mm in diameter.However, the dimensions of the target site or the extraction site,including the depth and angular orientation of tooth sockets will varydepending on the individual. Therefore, great care should be taken inensuring that the annular space 124 is suitable for a given implant andjawbone.

FIG. 5A is a cross-sectional perspective view of the jawbone 100 shownin FIG. 4. However, FIG. 5A also illustrates an implant 140 that isplaced at the prepared site 120. As illustrated therein, the implant 140comprises a lower portion 142 that is hollow and generally cylindrical.The lower portion 142 also comprises an exterior surface having aplurality of exterior threads 144 and interior cavity having a pluralityof interior threads 146. Nevertheless, in other embodiments, the implant140 can also comprise a lower portion 142 that is solid. Such anembodiment may be useful for implant sites in which less room isavailable and/or the depth of the implant must be limited, such as witha shorter tooth socket(s).

The “pitch” of a screw thread is generally defined as the distance fromone thread groove to the next measured axially. “Lead” is generallydefined as the distance a screw thread advances in one revolution.“Start” is a term that generally refers to the number of independentscrew threads on a screw member. The “lead” of a screw member is equalto the pitch of the screw member multiplied by the number of starts onthe screw member. In an embodiment, the interior and exterior threads146, 144 have the same pitch and preferably have the same lead. Inaccordance with another embodiment, the interior threads 146 can havedouble or quadruple starts while the exterior threads 144 have a singlestart. Further, in another embodiment, the exterior threads 144 can havedouble or quadruple starts while the internal threads 146 have a singlestart. Finally, it is contemplated that the internal and exteriorthreads 146, 144 can both comprise double or quadruple starts. Inanother embodiment, one or both of the interior and exterior threads146, 144 can be replaced with annular grooves, ridges, roughed ortextured surfaces.

As illustrated in FIG. 5A, the interior threads 146 of the implant 140are configured to engage the bone post 120 of the prepared site 110.Similarly, the exterior threads 144 of the implant 140 are configured toengage the cavity or wall 122 of the prepared site 110. Thus, theimplant 140 can be securely retained within the annular space 124 of theprepared site 110. Additionally, osseointegration of the bone 104 aboutand within the implant 140 will provide further stabilization andengagement between the implant 140 and the jawbone 100.

FIG. 5B illustrates a cross-sectional side view of the jawbone 100 andthe implant 140 illustrated in FIG. 5B. However, FIG. 5B alsoillustrates a final restoration 160 that is installed on the implant140. One of the innovative features of embodiments disclosed hereinprovides that the implant 140 can be generally centered relative to acenterline 180 of the prepared site 110. In this regard, the finalrestoration 160 will tend to be in an alignment similar to the originaltooth that is centered and spaced natural relative to adjacent teeth.Thus, unlike an angled abutment that would otherwise be installed in asocket 114 and contribute to an off-centered final restoration as shownin FIG. 3, embodiments of the implant 140 allow the final restoration tobe centered with respect to a centerline 180 of the site 110. Thus, thefinal restoration 160 will tend to be aesthetically superior to theprevious final restoration 16 shown in FIG. 3.

With reference now to FIGS. 6A-14, methods and tools for preparing theprepared site 110 will now be described in greater detail. FIG. 6A is aperspective view of a trephine drill 200 for creating an osteotomy atthe target site. The trephine drill 200 has a cylindrically-shapedtubular body 202 with a plurality of teeth 204 at a distal end 206thereof. The drill 200 can also include a plurality of depth markers 208for aiding the surgeon in achieving a desired depth of the osteotomy.The body 202 of the drill 200 can also be formed to a desired length. Asshown in FIG. 6B, which is a cross-sectional side view of FIG. 6A, thedrill 200 can comprise a body 202 having a hollow bore 209. In someembodiments, the length of the body 202 of the drill 200 can beapproximately 5 mm.

Further, the drill 200 can define an inner and outer diameter thatproduces a circular cut in bone. In use, a surgeon can select a drillhaving desired inner and outer diameters based on the geometry of thetarget site. For example, the inner and outer diameters of the variousembodiments of drills disclosed herein can correspond to the dimensionsof tools and/or to an implant, as discussed herein. As discussed below,the inner and outer diameters can be approximately equal to the outerminor diameter of the threads on the implant and the inner diameter ofthe drill 200 is approximately equal to the inner minor diameter of thethreads on the implant. In this regard, a “minor” diameter can bedefined as the diameter of an imaginary coaxial cylinder that justtouches the roots of an external thread or the crests of an internalthread. In this manner, the drill preserves bone material for engagingthe threads. In other embodiments, the inner diameter of the drill 200can be approximately greater than to the inner minor diameter of theimplant and the outer diameter of the drill 200 can be approximatelyless than the outer major diameter of the implant. In this regard, a“major” diameter can be defined as the diameter of an imaginary coaxialcylinder that just touches the roots of an internal thread or the crestsof an external thread.

As noted above with respect to U.S. Patent Application Publication No.2008/0003539, a trephine drill can be used in oral surgery to prepare anextraction site. Therefore, in accordance with an aspect of at least oneof the embodiments herein, the trephine drill 200 can be used forcreating an osteotoemy. In particular, the drill 200 can be used tocreate an implantation space that extends into the bone of the jaw andtraverses one or more of the existing tooth sockets. In this manner, theimplantation space can define a sufficiently large surface area alongwhich a dental implant can be engaged, such as by threaded engagement orotherwise. However, it is contemplated that other equipment can be usedin preparing the target site and creating an osteotomy having a shapeother than circular or cylindrical. For example, it is contemplated thatan osteotome can also be used to prepare the target site. An osteotomecan be used to improve the bone quality, such as by compaction of localbone, and bone quantity, by ridge extension in horizontal and verticaldimension. The osteotome can thus improve these aspects of the bone inorder to enhance the stability of an implant.

For example, as shown in FIG. 6C, the drill 200 can be used at an targetsite 220. After the site 220 has been cleaned, the drill 200 can beplaced with an axis of the drill 200 being aligned generally vertical ornormal relative to the jawbone. The osteotomy should be done to adesired depth. For example, the surgeon can use the depth markers 208 inassessing the depth of the osteotomy.

In some embodiments, the drill 200 can be modified to comprise one ormore torque transmitting sections 210 disposed along a shaft 212 of thedrill 200 which can be engaged, along with a proximal engagement section214, by a turning instrument in order to rotate the drill 200. Thetorque transmitting section 210 can be formed as a hex or othergeometric shape configured to provide secure engagement and transfer oftorque between a turning instrument and the drill 200. Further, the useof the torque transmitting section 210 can ensure that the shaft 212 ofthe drill 200 does not jam in the turning instrument, which may commonlyoccur if only the proximal engagement section 214 is used due to thesignificant torque that is exerted on the proximal engagement section214.

Furthermore, as shown in FIG. 7A, some embodiments provide for atrephine drill 240 that can be configured to include a facing burr orburr component 242 disposed in a hollow bore 244 of the drill 240. Acutting edge 246 of the facing burr 242 can be longitudinally spacedfrom a distal end 248 of the drill 240 at a given distance 250. Thedistal end 248 of the drill 240 can be defined generally by the teeththereof.

Therefore, the drill 240 can be configured such that in use, thedistance 250 defines a height of a bone post upon cutting theinterradicular bone at the target site. Further, the trephine drill 240can be used not only to create the bone post, but can also create anannular space at the target site in a single pass. In embodiments of theprocedures described herein, the use of the drill 240 could result inmultiple steps of the procedure being combined into a single step, thussimplifying the procedure and shortening the operation time. However, itis contemplated that in other embodiments such a combination drill mayalso be separated into a trephine drill and an interradicular burr orcoring tool as described further herein. The performance of the stepsindividually may allow a surgeon to precisely control and respond tooperational conditions.

In an embodiment, the drill 240 can have inner and outer diameters 252,254 that generally correspond to the dimensions of the implant that willbe used. Similar to the drill 200 discussed above, in an embodimentwherein an implant comprises inner and outer threads, the outer diameter254 of the drill 240 can be approximately equal to the outer minordiameter of the threads on the implant and the inner diameter 252 of thedrill 240 is approximately equal to the inner minor diameter of thethreads on the implant. In other embodiments, the inner diameter 252 ofthe drill 240 can be approximately greater than the inner minor diameterof the implant and the outer diameter 254 of the drill 240 can beapproximately less than the outer major diameter of the implant.

Additionally, the inner and outer diameters of the drill 240 cancorrespond to a guide sleeve described further herein. The inner andouter diameters of the drill 240 can also correspond to a try-incomponent, which is also described further herein. In some embodiments,the inner and outer diameters of the drill 240 can be selected in orderallow the drill 240 to create an annular space within the bone in orderto allow one or more of a guide sleeve, a try-in component, and atubular implant to be received therein.

In some embodiments of the procedure, a guide tool 260 can be used. Anembodiment of the guide tool 260 is shown in FIGS. 8A-B. The tool 260can be used in a variety of orientations during a procedure. The guidetool 260 is illustrated as an elongate shaft having first and secondends 262, 264 at which one or more respective support elements 266, 268are placed. The length of the elongate shaft of the tool 260 can bemodified as required. However, it is contemplated that the length may bebetween approximately 150 mm and approximately 200 mm. Morespecifically, the length of the shaft can be between approximately 165mm and approximately 189 mm.

As mentioned above, one of the advantages of some of the embodimentsdisclosed herein is that the guide tool 260 can be used to assist in theplacement and use of other tools, such as the trephine drill and thefacing burr. The guide tool 260 can be particularly advantageous becauseit can allow a surgeon to have greater control of and precisely supporta tool in a given orientation during use of the tool. Thus, the surgeoncan be enabled to precisely place tools during procedures, improvecutting accuracy, and more safely handle the tools.

In some embodiments, the guide tool 260 can be part of a surgicaltemplate. For example, a surgical template such as in the Applicant'sNobelGuide™ system can be used. Such surgical templates are described inU.S. Patent Application Publication Nos. 2004/0259051, filed on Jun. 23,2004, 2007/0281270, filed on Jul. 4, 2005, 2006/0006561, filed on Jun.30, 2005, and 2008/0118895, filed on Jul. 4, 2005, U.S. Patent ApplicantSer. No. 11/916,262, filed on Nov. 30, 2007, as well as InternationalPatent Application Nos. PCT/SE02/02393, filed on Dec. 19, 2002,PCT/SE2005/001074, filed Jul. 4, 2005, the entireties of which areincorporated herein by reference.

In accordance with an embodiment, the first and second ends 262, 264 canbe angled. The angular orientation of the first and second ends 262, 264can be different in order to allow a surgeon flexibility in using thetool 260 depending on local geometries of the buccal cavity of thepatient. The first and second ends 262, 264 can be oriented at anglesranging from approximately 0° to approximately 50°. In the illustratedembodiment, the angle is approximately 40°.

In some embodiments, the support elements 266, 268 can be formed ascontinuous annular structures having a given inner diameter. However,the support elements 266, 268 can also define a discontinuous perimeteror be formed in a shape other than annular. The support elements 266,268 can define respective receiving apertures having interior geometriesthat are configured to receive at least one tool. For example, the innerdiameters of the support elements 266, 268 can correspond to an outsidediameter of a tool used in an embodiment of the implant proceduresdescribed herein for allowing the tool to be received by the supportelement. In an embodiment, the inner diameter of the support element 266at one end can be different from the inner diameter of the other supportelement 268 at the other, opposite, end. In this manner, the tool 260can be selectively configured to be used with more than one tool. Thesupport element can engage the tool in such a manner that allows thetool to spin relative to the support element while allowing a surgeon tomore precisely manipulate the position and orientation of the tool usingthe guide tool.

In some embodiments, the first and second ends 262, 264 can comprise oneor more support grooves 270 disposed adjacent to the support elements266, 268. The grooves 270 can be configured to allow the first andsecond ends 262, 264 to be more easily accommodated at the target site.Further, the grooves 270 can be disposed along the top and bottomportions of the first and second ends 262, 264 for flexibility of use invarious orientations.

Additionally, as shown in FIG. 8A, the support elements 266, 268 candefine a guide surface 272 having a height 274. Thus, in someembodiments, the guide surface 272 can be a generally cylindricalsurface. The guide surface 274 can therefore restrict degrees of freedomof movement between the guide tool 260 and a tool being engaged by theguide tool 260.

For example, as shown in FIG. 8B, the support element 268 of the guidetool 260 can be configured to support a trephine drill 280 duringperformance of the procedure. Due to the cylindrical fitting between theguide tool 260 and the drill 280, only relative rotational movementalong a longitudinal axis of the drill 280 and longitudinal slidingmovement will be possible between the tool 260 and the drill 280,thereby allowing the tool 260 to control longitudinal and rotationalmovement of the drill 280 along axes transverse to the longitudinal axisof the drill 280. Thus, a surgeon can use both the tool 260 and thedrill 280 to accurately place the drill 280 at the target site.

The use of the guide tool 260 can be especially advantageous when thetrephine drill 280 is used at a target site having several toothsockets. The portion of the target site that lies at the surface of thejawbone where the tooth sockets converge can often be defined by severalsharp edges. As such, without the use of the guide tool 260, it can beparticularly difficult to place the trephine drill 280 in such a manneras to maintain a desired position and trajectory of the drill 280.During use, the trephine drill 280 can sometimes be very unstable andwobble when it contacts the gum tissue and/or the bone. Suchdifficulties may also be present when using other tools as well.However, by using the guide tool 260, the surgeon can maintain a desiredposition even against sharp edges of varying heights. Further, thetrajectory of the drill 280 can also be precisely controlled, thusoptimizing the osteotomy.

Accordingly, it is contemplated that various components and dimensionsof the guide tool 260 can be selectively modified so that the guide tool260 can be used with tools of differing shapes and sizes. For example, asingle guide tool can correspond to two trephine drills of differentouter diameters. Further, the guide tool could correspond to a singlediameter drill, but provide different angular orientations of supportelements at the first and second ends of the guide. This versatility ofthe guide tool can allow a surgeon, if using the guide tool, to achievea greater degree of precision and accuracy in using tools during theperformance of a procedure.

In other embodiments of the procedure, a facing burr 300 can optionallybe used to prepare the target site. In other words, the facing burr 300can be used prior to the use of the trephine drill 200 in order toprovide a smooth and/or flat surface against which the trephine drill200 can be applied. Accordingly, the smooth and/or flat surface can aidthe surgeon in aligning the trephine drill 200 such that the osteotomycan be properly centered and oriented in a desired manner.

Thus, the facing burr 300, such as shown in FIG. 9A, can be used tocreate a smooth and/or flat upper surface at the target site. Further,in some embodiments, the diameter of the facing burr 300 can be equal tothe diameter of the trephine drill 200, as discussed above. However, itis also contemplated that the diameter of the facing burr 300 can belarger than the diameter of the trephine drill 200. Thus, in someembodiments, the burr 300 can prepare the target site to have agenerally flat and smooth upper surface that extends circumferentiallyaround the osteotomy created by the trephine drill 200.

Further, the facing burr 300 can be configured to include a plurality ofdepth markers 304. In use, the depth markers 304 can be monitored by thesurgeon in order to allow the surgeon to be aware of and control thedepth of the cut.

As discussed herein, the target site can be a tooth or molar extractionsite. Accordingly, in some embodiments, it may be advantageous to smoothan upper surface of the target site. However, it is also contemplatedthat the upper surface at the target site may already be sufficientlysmooth or it may be unnecessary to smooth out the upper surface.Therefore, the use of the facing burr 300 is optional in certainembodiments. As noted above, if the facing burr 300 is used, the facingprocedure can be performed before the trephine drill or other tool hasbeen used to create the osteotomy.

In embodiments of the procedure that utilize the facing burr 300, blades302 of the facing burr 300 can be placed at a target site 310 as shownin FIG. 9B. The burr 300 rotates such that the blades 302 cut into thetarget site 310 to produce a smooth upper surface 312.

In some embodiments, the facing burr 300 can be used with a guide tool,such as the guide tool 260 described above. As such, a surgeon can moreprecisely place the burr 300 during the facing procedure. In particular,in one embodiment, a support member 266 of the guide tool 260 isconfigured to slideably receive the trephine drill 280 while the othersupport member 264 is configured to slideably receive the facing burr300. In such a configuration, the guide surfaces 272 of the supportmembers 266 preferably have an inside diameter that is slightly largerthan the outside diameter of the corresponding tool.

The burr 300 can also comprise one or more torque transmitting sections320 disposed along a shaft 322 of the burr 300 which can be engaged,along with a proximal engagement section 324, by a turning instrument inorder to rotate the burr 300. The torque transmitting section 320 can beformed as a hex or other geometric shape configured to provide secureengagement and transfer of torque between a turning instrument and theburr 300. Further, the use of the torque transmitting section 320 canensure that the shaft 322 of the burr 300 does not jam in the turninginstrument, which may commonly occur if only the proximal engagementsection 324 is used due to the significant torque that is exerted on theproximal engagement section 324.

FIG. 9C illustrated another embodiment of a facing burr 330. The facingburr 330 can comprise at least some of the features discussed above withrespect to the facing burr 300. However, in addition, the facing burr330 can also comprise a tip 332 disposed at a distal end 334 of thefacing burr 330. In this regard, as shown in FIG. 9C, the tip 332 canextend from one or more blades 336 of the burr 330. The tip 332 of someembodiments of the facing burr can facilitate centering of the facingburr during use. For example, when the facing burr is being used toprepare an uneven surface, it may be difficult to center and maintainlevel or even the face or plane of the blades 336. Accordingly, thecentering function of the tip 332 can enable a surgeon to reliablyprepare the target site to a level and even surface. In particular, thetip can be especially useful when preparing a healed site. Otherwise, itis possible that the facing burr may move during use.

Referring now to FIGS. 10A-C, embodiments of the procedure can also beperformed using a guide sleeve 360. As shown in FIG. 10A, the guidesleeve 360 can comprise a hollow body 362 that is configured tocorrespond to the cross-sectional shape of the osteotomy prepared by thetrephine drill or other tool. Thus, in some embodiments, the body 362 isgenerally a hollow tubular or cylindrical shape that generallycorresponds to the shape of the trephine drill in order to ensure thatthe sleeve 360 can be placed at or within the osteotomy created by thedrill. In such embodiments, the hollow body 362 has an inner and outerdiameter that substantially corresponds to the inner and outer diameterof the trephine drill.

The cross-sectional view of FIG. 10B illustrates the placement of theguide sleeve 360 in an osteotomy 370 created at the target site 372. Inthis manner, the guide sleeve 360 can be used for subsequent steps inthe procedure, as described herein, that further modify the target sitein order to create a prepared site that is capable of receiving a dentalimplant. In particular, the guide sleeve 360 can serve to ensure thatadditional tools used in the procedure are properly aligned relative tothe osteotomy 370. For example, in some embodiments, the sleeve 360 canbe used to coaxially or vertically align additional tools relative tothe osteotomy 370. Further, other embodiments described herein allowadditional tools to be horizontally aligned or controlled using thesleeve 360, such as limiting the depth of such tools.

In some embodiments, the guide sleeve 360 can comprise a transverseflange 374 at a proximal end 376 thereof. The flange 374 can be used tofacilitate handling of the sleeve 360 during placement and removal ofthe sleeve 360. In addition, some embodiments of the procedure canprovide that the sleeve 360 is used with a guide tool, such as the guidetool 260 described above. Such an embodiment of the procedure is shownin FIG. 10C. Thus, a guide tool 380 can be used by a surgeon to placethe sleeve 362 at an osteotomy of a target site 382.

Referring now to FIGS. 11A-C, and additional aspect of embodiments ofthe procedure is shown. FIG. 11A illustrates an embodiment of aninterradicular burr or bone coring tool 400 that can be used inpreparation of the target site. The term “coring” can refer generally tothe process of drilling into the bone of the patient in order to removebone material and to prepare the osteotomy. Although the tool 400 isreferred to as a coring tool, it is contemplated that the coring processcan be performed using a variety of other tools and guides, as describedherein. The coring process can also refer to the process of removing aportion of the bone post such that the bone post defines a selectedheight.

The bone coring tool 400 may be necessary in order to achieve theprepared site 110 shown in FIG. 4. The tool 400 can optionally be usedin embodiments of the procedure. The tool 400 can comprise an elongatebody, a distal cutting face 402, and a plurality of flutes 404 that runlengthwise along the elongate body of the tool 400.

In addition, the tool 400 can comprise one or more torque transmittingsections 406 disposed along a shaft 408 of the tool 400 which can beengaged, along with a proximal engagement section 410, by a turninginstrument in order to rotate the tool 400. The torque transmittingsection 406 can be formed as a hex or other geometric shape configuredto provide secure engagement and transfer of torque between a turninginstrument and the tool 400. Further, the use of the torque transmittingsection 406 can ensure that the shaft 408 of the tool 400 does not jamin the turning instrument, which may commonly occur if only the proximalengagement section 410 is used due to the significant torque that isexerted on the proximal engagement section 410.

In some embodiments, the tool 400 can be placed into a guide sleeve 420that has been placed in an osteotomy 422 at a target site 424 in orderto perform a coring procedure. The guide sleeve 420 can be configured ina manner similar to that of the guide sleeve 360 described above. Thetool 400 can therefore be configured to fit within the interior diameterof the sleeve 420. In this manner, a longitudinal axis of the tool 400can be substantially coaxially aligned with a longitudinal axis of theosteotomy 422. For example, the outer diameter of the tool 400 can beconfigured relative to the inner diameter of the sleeve 420 such thatonly a small gap is present between the sleeve 420 and the tool 400. Insome embodiments, the gap is approximately between 0.05 mm to 0.3 mm.

In addition, the tool 400 can comprise a limit flange or portion 434that can contact an upper portion 436 of the guide sleeve 420. The upperportion 436 of the guide sleeve 420 can be formed as a circular edge, aflange, a movable component, or one or more protrusions extending fromthe guide sleeve 420. In this regard, the length of the tool 400 and thelength of the guide sleeve 420 can be configured such that the tool 400is permitted to descend into the guide sleeve 420 and cut into the bonepost 430 up until contact occurs between the limit flange 434 of thetool 400 and the upper portion 436 of the guide sleeve 420. The contactbetween the limit flanges 434 and the upper portion 436 can limit thedepth to which the tool 400 can penetrate, as shown in FIG. 11C. Assuch, the bone post 430 can be formed to a specific height 438 anddiameter 440. In some embodiments, the tool 400 of the sleeve 420 can beconfigured such that the resultant bone post 430 has a height ofapproximately 2 mm. However, the height of the bone post 430 can beselectively adjusted by altering one of the length of the tool 400 orthe length of the sleeve 420. Accordingly, by using the sleeve 420, thebone post 430 can be cut to a desired dimension while ensuring that thetool 400 does not contact or damage the sides of the osteotomy.

For example, it is contemplated that the tool 400 can be configured suchthat the height 438 of the bone post 430 is determined by the differencebetween a effective longitudinal length 442 of the tool 400 and aneffective longitudinal length 444 of the guide sleeve 420. The length442 of the tool 400 can be calculated as the distance from the flange434 thereof to the distal end of the tool 400. Accordingly, when thetool 400 is inserted into the guide sleeve 420, the flange 434 caneventually contact the upper portion 436 of the sleeve 420 to preventfurther axial movement of the tool 400 into the sleeve 420. As shown inFIG. 11C, embodiments provide that the effective longitudinal length 444of the sleeve 420 is greater than the operative longitudinal length 442of the tool 400, thus allowing the bone post 430 to remain within andhave its height 438 extending into the sleeve 420.

It is also contemplated that a plurality of tools 400 can be providedthat each defines different operative longitudinal lengths 442.Depending on a given procedure, a surgeon could select a given tool 400based on the needed dimensions of the bone post. Further, a plurality ofguide sleeves 420 could be provided that each defines differentlongitudinal lengths 444 in order to allow the surgeon to configure thebone post as desired.

Additionally, the tool 400 and/or the sleeve 420 can be configured suchthat the respective lengths 442, 444 thereof are selectively adjustable.For example, the flange 434 can be translatable along the longitudinalaxis of the tool 400 in order to adjust the operative longitudinallength 442 of the tool 400. The flange 434 could be adjustable to one ofa plurality of positions along the tool 400. The flange 434 can beadjusted using snap fit, rotational locking, or other means foradjusting and fixing the axial position of the flange 434. Indeed, thepositions could allow adjustment of the operative longitudinal length442 in 0.5 mm or 1 mm increments. Similarly, the length 444 of thesleeve 420 can be selectively adjusted using similar means.

Accordingly, when rotated, the cutting face 402 of the tool 400 will cutinto a bone post 430 formed by the osteotomy 422 to thereby create aplanar top surface 432 on the bone post 430. Accordingly, the bone post430 can take on a shape that is generally cylindrical and have a topsurface 432 that is oriented generally perpendicular relative to alongitudinal axis of the bone post 430. As will be described furtherherein, the formation of a finished bone post 430 can allow a tubulardental implant such as those described herein to be received at thetarget site. In particular, and in some embodiments, the geometry of thebone post 430 can be configured to correspond to the geometry of adental implant and can contribute to the stability and fit of theimplant at the target site.

During the coring procedure, bone material 460 that is removed from anupper section of the bone post 430 can be received within the flutes 404of the tool 400, as shown in FIG. 11D. The bone material 460 can beadvantageously collected using the sleeve 420 described above. Thesleeve 420 can provide a non-compressible, non-porous surface againstwhich the bone material can be pressed and urged into the flutes 404 ofthe tool 400. Further, residual bone material can also be collected fromwithin the sleeve 420 when the coring process is finished.

The collection of bone material during the coring process can provide asurgeon with bone material that can later be grafted into portions orsockets of the target site. It is generally know that autogenous bonematerial is more likely to be successfully grafted into a given bonearea. However, in accordance with at least one of the embodimentsdisclosed herein is the realization that bone material can be collectedduring the implant placement procedure and can later be used to fill ingaps at the target site. As such, although in implant will be generallystable when installed in the annular space of a prepared site, the bonematerial collected during the procedure can be grafted into the socketsaround the implant such that the implant will be even more securelyretained once the graft is healed.

In accordance with another embodiment, the dental implant placementprocedure can optionally comprise the step of tapping the osteotomy tocreate a series of threads along an outer surface of the bone postand/or the inner surface of the cavity formed by the osteotomy. Ifneeded, a tapping tool can be used to further configure the preparedsite 110 referred to in FIG. 4. This optional step can be performed whenplacing an implant into dense bone.

FIGS. 12A-B illustrate a tapping tool 470 and an exemplary manner ofuse. The tapping tool 470 can comprise an elongate shaft 472 that iscoupled to a tapping portion 474 located at a distal end of the shaft472. In addition, the shaft can comprise one or more torque transmittingsections 476 which can be engaged, along with a proximal engagementsection 478, by a turning instrument in order to rotate the tool 470.The torque transmission section 476 can be formed as a hex or othergeometric shape configured to provide secure engagement and transfer oftorque between a turning instrument and the tool 470. Further, the useof the torque transmitting section 476 can ensure that the shaft 472 ofthe tool 470 does not jam in the turning instrument, which may commonlyoccur if only the proximal engagement section 478 is used due to thesignificant torque that is exerted on the proximal engagement section478.

Additionally, some embodiments of the tapping tool 470 can comprise oneor more depth markers 490. As such, during the tapping process, the tool470 can be inserted up to a desired depth at an target site 494 whichcan be monitored using the depth markers 490. Further, the tool 470 canbe configured to define a length of approximately 5 mm. However, it iscontemplated that the length of the tool 470 can be increased ordecreased in order to allow a surgeon greater flexibility andversatility during the implantation process. Furthermore, the diameterof the tapping portion 474 can also be varied in order to correspond tothe diameter of a given osteotomy. For example, it is contemplated thata plurality of tapping tools 470 can be available to the surgeon inorder to accommodate length and diameter requirements of the tool 470for a given procedure.

FIG. 13 is a perspective view of a try-in component 500. The try-incomponent 500 can be used as a temporary prosthetic that simulates how anew implant and/or abutment would be received and fit into the preparedsite. The component 500 can therefore simulate either a one-pieceimplant or a multi-piece implant. The try-in component 500 can comprisea body portion 502 and an upper portion 504. In the embodimentillustrated in FIG. 13, the try-in component 500 includes a hollowinterior 506 within the body 502. In addition, the try-in component 500can comprise a circumferential groove 508 that extends about the bodyportion 502. The groove 508 can be configured to indicate, for example,a transition point from an implant portion to an abutment portion for asingle-piece implant, or for a multi-piece implant, a transition pointfrom the implant to an abutment.

The try-in component 500 can be configured to mimic the dimensions of adental implant. For example, the try-in component 500 can be configuredsuch that it defines an overall height that matches an overall height ofa dental implant and/or an abutment that can be attached to the dentalimplant. The location of the circumferential groove 508 can correspondto a height of the threads of an implant or to a top surface of animplant. Additional important dimensions, such as the shape of the upperportion 504, the depth of the hollow interior 506, and the diametertaken along one or more points on the body portion 502 can likewise beconfigured to match those of a corresponding dental implant.

In use, in embodiments of the procedure, the try-in component 500 can beplaced at a prepared site, such as the prepared site 110 illustrated inFIG. 4. Because the try-in component 500 has been configured togenerally match or approximate the important dimensions of acorresponding dental implant, the component 500 can be placed andobserved in order to determine whether the corresponding implant wouldproperly fit at the prepared site. For example, one of the observationsthat can be made is whether the annular space extends to a sufficientdepth for receiving the implant. As noted above, the component 500 caninclude a groove 508 that corresponds to the thread height or topsurface of the implant and that can serve as a visual indicator as towhether the annular space extends to a sufficient depth. Additionally,the upper portion 504 of the component 500, which can correspond to anupper portion of an implant and/or an abutment that has been attached tothe implant, can be compared relative to the surrounding dentition andcan be checked for clearance under occlusion.

FIGS. 14A-C illustrates an embodiment of a dental implant 600 that canbe used in accordance with an embodiment of the dental implant placementprocedure discussed herein. As shown, the implant 600 can be configuredas a single-piece implant. The implant 600 can comprise a threadedportion 602 and an abutment portion 604. The implant 600 can compriseengaging means for engaging at least a portion of the prepared site. Insome embodiments, the engaging means can comprise a plurality of threads606 that are disposed along the threaded portion 602. However, otherstructures can also be utilized to secure the implant 600 relative tothe bone.

Additionally, as shown in FIG. 14B, the implant 600 can comprise aninner cavity 620 that extends at least partially from a bottom face 622of the implant 600 toward a top face 624 thereof. The inner cavity 620and the bone post of the prepared site can be configured to correspondto each other such that when the implant 600 is seated or installed inthe prepared site, the bone post is generally engaged by the innercavity 620. In this regard, the inner cavity 620 can be approximately1.9 mm in depth in order to correspond to a bone post having a height ofapproximately 2 mm. However, other configurations can be preparedwherein the heights of the inner cavity and the bone post correspond toeach other. Further, the engaging means of the implant 600 can furthercomprise a plurality of threads 626 that are disposed along and interiorsurface of the inner cavity 620. In some embodiments, such as thatillustrated in FIG. 14B, the threads 626 can be configured as internalthreads.

The implant 600 can also comprise a tool engagement portion 640extending from the top face 624 towards the bottom face 622 of theimplant 600. The engagement portion 640 can comprise a socket 644 thatis configured to mate with a turning tool such that a torque from theturning tool can be effectively transferred to the implant 600. Asillustrated, the socket 644 can be configured as a hexagon. However, itis contemplated that the socket 644 can be any variety of geometricshapes, such as triangular, square, or any other screw drive types, suchas philips, pozidriv, torx, tri-wing, torq-set, or triple-square, toname a few. In addition, the tool engagement portion 640 can alsocomprise a conical and threaded connection 642 that can be used tocouple an abutment to the implant.

FIG. 14C illustrates installation of the implant 600 into a preparedsite 650 created at a target site 652. As shown, the threads 606 of theinstalled implant 600 can engage a cavity or wall 660 of an annularspace 662 of the prepared site 650. Further, the threads 626 can alsoengage a bone post 664 of the prepared site 650. Finally, it is alsonoted that in some embodiments of the procedure, bone material may havebeen collected during the coring procedure using the interradicular burror coring tool. Thus, with respect to FIG. 14C, it is noted that a toothsocket 670 can be filled with the bone material collected during thecoring procedure. As a result, in addition to the engagement between thethreads 606 and the wall 660 and the engagement between the threads 626and the bone post 664, which sufficiently anchors the implant 600 at thetarget site 652, the grafting of bone material into the tooth socketscan enhance the engagement between the implant 600 and the target site652.

With reference now to FIG. 15, and implant driver 700 is shown. Theimplant driver can comprise an elongate shaft 702, a proximal engagementsection 704, a torque transmitting section 706, and an implant drivingsection 708. The driver 700 can be attached to a turning instrument bymeans of the proximal engagement section 704, which can allow a torquefrom the turning instrument to be transmitted to the driver 700. Theimplant driving section 708 can be configured to mate with a toolengagement portion of an implant for driving or turning the implant inorder to install the implant.

In some embodiments, the driver 700 can comprise one or more torquetransmitting sections 706 disposed along the shaft 702 which can beengaged, along with a proximal engagement section 704, by the turninginstrument in order to rotate the driver 700. The torque transmittingsection 706 can be formed as a hex or other geometric shape configuredto provide secure engagement and transfer of torque between a turninginstrument and the driver 700. Further, the use of the torquetransmitting section 706 can ensure that the shaft 702 of the driver 700does not jam in the turning instrument, which may commonly occur if onlythe proximal engagement section 704 is used due to the significanttorque that is exerted on the proximal engagement section 704. Finally,the implant driving section 708 can be formed as a tip that includes oneor more radially extending protrusions. In some embodiments, the implantdriving section 708 can comprise 4, 6, or 8 radially extendingprotrusions. These protrusions can be arranged in a pattern in which theprotrusions lie circumferentially equidistant relative to each other.However, the protrusions can also be arranged in a variablecircumferential spacing about the implant driving section 708.

In accordance with another embodiment, FIGS. 16-20 illustrate an implantdriver 800 that can be used to install an embodiment of the implantsdiscussed herein. The driver 800 can comprise an elongate shaft 802, aproximal engagement section 804, a torque transmitting section 806, andan implant driving section 808. Similarly to the implant driver 700discussed above, the driver 800 can be attached to a turning instrumentby means of the proximal engagement section 804, which can allow atorque from the turning instrument to be transmitted to the driver 800.The implant driving section 808 can be configured to mate with a toolengagement portion of an implant for driving or turning the implant inorder to install the implant.

In addition, some embodiments of the driver 800 can be configured toinclude one or more torque transmitting sections 806. The one or moretorque transmitting sections 806 can be disposed along the shaft 802.The one or more torque transmitting sections 806 can be engaged, alongwith the proximal engagement section 804, by a turning instrument inorder to rotate the driver 800. The torque transmitting section 806 canbe formed as a hex or other geometric shape configured to provide secureengagement and transfer of torque between a turning instrument and thedriver 800.

The implant driver 800 can optionally include one or more retentionstructures 810. The retention structure 810 may be used to facilitateinteraction between the implant driver and the implant or between theimplant driver and the turning instrument. For example, the retentionstructure 810 may aid in removably coupling the implant driver to theimplant or the implant driver to the turning instrument.

The retention structure is 810 can be disposed along the elongate shaft802 of the driver 800. As illustrated in FIGS. 16-18, the retentionstructure 810 can be disposed adjacent to the torque transmittingsection 806. In the illustrated embodiment, the retention structures 810can be disposed intermediate the torque transmitting section 806 and theimplant driving section 808.

The embodiment illustrated in FIG. 16 shows that the retention structure810 can comprise a plurality of indentations. These indentations can becircumferentially spaced about a portion of the implant driver 800. Insome embodiments, the indentations can be generally conical in shape;however, various other shapes can be used. As shown in FIGS. 16-18, theretention structure 810 can be monolithically formed with the torquetransmitting section 806. Such an embodiment may advantageously allowquick and secure engagement between the implant driver 800 and theturning instrument. It is also contemplated that the retention structure810 can also comprise a plurality of protrusions or bumps. Suchprotrusions can be circumferentially spaced about a portion of theimplant driver 800.

Additionally, the embodiment illustrated in FIGS. 16-18 can alsocomprise an alignment portion 312. The alignment portion 312 can extendfrom a distal end of the driver 800. The alignment portion 312 can bereceived to within a connection aperture of an implant, such as athreaded hole thereof. In this regard, the alignment portion 312 can bea generally cylindrical, conical, or other shape that allows thealignment portion 312 to aid in centering the driver 800 as the distalend of the driver 800 is inserted into the implant.

FIGS. 19 and 20 are end views of the implant driver 800. FIG. 19 is aproximal end view illustrating a hexagonal configuration of the torquetransmitting section 806 in accordance with an embodiment. Thisembodiment, as illustrated in FIGS. 16-19, can be configured such that aportion 820 of the driver 800 forms the torque transmitting section 806and the retention structure 810. In an embodiment, the portion 820 ofthe driver 800 can comprise a generally cylindrical structure in whichthe retention structure 810 is formed and a multifaceted structure inwhich the torque transmitting section 806 is formed. As illustrated inFIG. 19, the cylindrical structure of the portion 820 can have a greatercross-sectional geometry than the multifaceted structure. Such a featuremay be advantageous in facilitating engagement between the implantdriver 800 and a turning instrument.

FIG. 20 is an end view of a distal end of the implant driver 800. Asillustrated, the implant driving section 808 can be hexagonally shaped.In some embodiments, the implant driving section 808 can have a smallercross-sectional profile than the portion 820 of the driver 800. Further,it is contemplated that the implant driving section 808 can beconfigured as a geometric shape other than a hexagon. For example, theimplant driving section 808 can be configured in a variety geometricsshapes such is triangular, square, and various other shapes that maycorrespond with a slotted screw drive, such as those listed above.

Although these inventions have been disclosed in the context of certainpreferred embodiments and examples, it will be understood by thoseskilled in the art that the present inventions extend beyond thespecifically disclosed embodiments to other alternative embodimentsand/or uses of the inventions and obvious modifications and equivalentsthereof. In addition, while several variations of the inventions havebeen shown and described in detail, other modifications, which arewithin the scope of these inventions, will be readily apparent to thoseof skill in the art based upon this disclosure. It is also contemplatedthat various combination or sub-combinations of the specific featuresand aspects of the embodiments may be made and still fall within thescope of the inventions. It should be understood that various featuresand aspects of the disclosed embodiments can be combined with orsubstituted for one another in order to form varying modes of thedisclosed inventions. Thus, it is intended that the scope of at leastsome of the present inventions herein disclosed should not be limited bythe particular disclosed embodiments described above.

1-52. (canceled)
 53. A combination for performing an implantation of animplant at a target site, the combination comprising: a guide sleevedefining inner and outer diameters, the guide sleeve comprising a limitflange at a proximal end thereof, the guide sleeve defining an effectivelongitudinal length; and a trephine drill defining inner and outerdiameters, the outer diameter of the trephine drill configured to fitwithin the inner diameter of the guide sleeve.
 54. A combination forcreating a prepared site for a dental implant, the combinationcomprising: a trephine drill defining inner and outer diameters; aninterradicular burr defining an outer diameter being less than the outerdiameter of the trephine drill; and a guide sleeve defining inner andouter diameters, the outer diameter being approximately equal to theouter diameter of the trephine drill, the inner diameter beingapproximately equal to the inner diameter of the trephine drill, theguide sleeve being configured to removably receive the interradicularburr therein.
 55. The combination of claim 54, wherein the guide sleevecomprises an upper portion at a proximal end thereof.
 56. Thecombination of claim 55, wherein the interradicular burr includes acorresponding limit flange configured to contact the upper portion ofthe guide sleeve when the interradicular burr is inserted into the guidesleeve.
 57. The combination of claim 56, wherein when the interradicularburr is inserted into the guide sleeve and the corresponding limitflange contacts the upper portion of the guide sleeve, theinterradicular burr defines an operational longitudinal length less thanan effective longitudinal length of the guide sleeve.